HomeMy WebLinkAbout2015 NOV MINOROwner /Operator: ,x-12 S , --q. A YA
Facility:
Address: e ,, s-r c-
DATE FOR
CORRECTION
There were N0 violations observed during this inspection
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N tlVe t® ®in ril,/I'9 I.rn ®/ Violations were found during this inspection as noted in the following
Summary of Violations.
The violations indicated in.this inspection report must be corrected within 30 days, unless
otherwise noted.
Formal enforcement may be initiated for any violations noted; and. for those. not corrected in a.
timely manner -, This report does not represent that there are no other violations at this facility. A
re- inspection may occur, °to .determine compliance status.
SUMMARY OF VIOLATIONS
Item VIOLATION
REQUIREMENT FOR CORRECTION OF.
VIOLATION.
DATE FOR
CORRECTION
Inspectors
Signature: j'.'"`.: Received by.
Phone: 1 Print Name: a V -" 0
f r' Date: -' ; r .. Date: L Q\Sl
r•_GRTiFlf_®T1f)N OF RETURN TO COMPLIANCE
I certify that the violations noted above on this Notice to Comply /Summary of Violations have been
corrected.' I have personally examined any documentation attached to.the certification to establish that
the violations have been corrected.
Signature: a'
Title:
Print Name:
Date:
KPS #8446
rn.,v +n ha QAnt in after Return- to- Comnliance Pink — Prevention Services Copy